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Xie J, Patil NS, Popovic MM, Kertes PJ, Muni RH, Schlenker MB, Ahmed IIK, Kohly RP. Association Between Sociodemographic Factors and Self-reported Glaucoma in the National Health Interview Survey: A Population-Based Analysis. Am J Ophthalmol 2024; 263:81-92. [PMID: 38387827 DOI: 10.1016/j.ajo.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/02/2024] [Accepted: 02/13/2024] [Indexed: 02/24/2024]
Abstract
PURPOSE To investigate the association between social determinants of health (SDH) in the domains of social and community context, education access, environmental context, economic stability, and healthcare access, with glaucoma prevalence. DESIGN Cross-sectional study. METHODS The study population consisted of adult participants who answered glaucoma-related questions on the 2017 National Health Interview Survey (NHIS), the most recent iteration that includes glaucoma-related questions. The main outcome measures included the relationships between SDH-related factors and self-reported glaucoma diagnosis as well as self-reported glaucomatous vision loss were examined using univariable and multivariable regression models. RESULTS In total, 26,696 of 26,742 (99.83%) NHIS respondents were included, of whom 880 (3.30%) reported a glaucoma diagnosis and 275 (1.03%) reported glaucomatous vision loss. Participants were predominantly middle-aged (50.95 ± 18.60 years), female (54.75%), and non-Hispanic White (70.49%). In age-adjusted multivariable regression (n = 25,456), non-Hispanic Black race (odds ratio [OR] = 1.87, 99% CI = [1.37, 2.55], P < .001, compared to non-Hispanic White race) and poor health status (OR = 1.54, 99% CI = [1.00, 2.37], P = .01, compared to good health status) were significant predictors of glaucoma diagnosis. For glaucomatous vision loss, having an income below the poverty threshold (OR = 2.41, 99% CI = [1.12, 5.20], P = .003, compared to income ≥5 times the poverty threshold) was the only significant predictor in univariable analyses. No SDH-related factors were significantly associated with glaucomatous vision loss in multivariable analysis (n = 848). Multicollinearity was minimal (variation inflation factor<1.6 for all independent variables). CONCLUSIONS Non-Hispanic Black race and poor health status were associated with self-reported glaucoma diagnosis. Physicians and policymakers may consider SDH when assessing clinical risk and designing public health interventions.
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Affiliation(s)
- Jim Xie
- From the Michael G. DeGroote School of Medicine (J.M., N.P.), McMaster University, Hamilton, Ontario, Canada
| | - Nikhil S Patil
- From the Michael G. DeGroote School of Medicine (J.M., N.P.), McMaster University, Hamilton, Ontario, Canada
| | - Marko M Popovic
- Department of Ophthalmology and Vision Sciences (M.P., P.K., R.M., M.S., I.A., R.K.), University of Toronto, Toronto, Ontario, Canada
| | - Peter J Kertes
- Department of Ophthalmology and Vision Sciences (M.P., P.K., R.M., M.S., I.A., R.K.), University of Toronto, Toronto, Ontario, Canada; John and Liz Tory Eye Centre (P.K, R.K.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Kensington Eye Institute (P.K., M.S.), Toronto, Ontario, Canada
| | - Rajeev H Muni
- Department of Ophthalmology and Vision Sciences (M.P., P.K., R.M., M.S., I.A., R.K.), University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology (R.M.), St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
| | - Matthew B Schlenker
- Department of Ophthalmology and Vision Sciences (M.P., P.K., R.M., M.S., I.A., R.K.), University of Toronto, Toronto, Ontario, Canada; Kensington Eye Institute (P.K., M.S.), Toronto, Ontario, Canada; Institute for Better Health, Trillium Health Partners (M.S., I.A.), Mississauga, Ontario, Canada
| | - Iqbal Ike K Ahmed
- Department of Ophthalmology and Vision Sciences (M.P., P.K., R.M., M.S., I.A., R.K.), University of Toronto, Toronto, Ontario, Canada; Institute for Better Health, Trillium Health Partners (M.S., I.A.), Mississauga, Ontario, Canada
| | - Radha P Kohly
- Department of Ophthalmology and Vision Sciences (M.P., P.K., R.M., M.S., I.A., R.K.), University of Toronto, Toronto, Ontario, Canada; John and Liz Tory Eye Centre (P.K, R.K.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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Wilt JK, Siminoff LA, Thomson MD. Pre-diagnosis Symptoms, Attributed Causes, and Healthcare Seeking Assets of Younger Colorectal Cancer Survivors. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1932-1938. [PMID: 37715897 DOI: 10.1007/s13187-023-02363-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 09/18/2023]
Abstract
Younger onset colorectal cancer (CRC) rates continue to rise. Survivors younger than the requisite age of population-based screening guidelines experience adverse symptoms, longer appraisal delays, and more advanced-stage diagnoses. This secondary analysis of interviews with n=252 recently diagnosed CRC survivors was completed to compare younger and older survivors' symptoms, attributed causes, and healthcare seeking assets. The original transcripts and quantitative data were divided into two survivor classifications, younger (age <50 years) (N=64) and older (N=188). Bivariate analyses assessed differences between younger and older survivors for symptoms, attributed causes, and seeking healthcare assets. Multiple logistic regression models adjusting for race, sex, income, education, and stage of diagnosis were conducted for significant bivariate findings. An α level .05 was used to detect significance. Bleeding (𝛘2=3.8, p =0.05) and loss of appetite/weight differed between survivors (𝛘2=5.3, p=0.02) but not after controlling for sex and race respectively. Younger survivors were more likely to report being too young/healthy to have cancer (𝛘2=7.8, p<0.01) and social support encouragement to seek healthcare (𝛘2=6.4, p=0.01). Having a regular healthcare provider was more common among older survivors (𝛘2=6.4, p=0.01). Logistic regression models also detected age as a significant predictor for all healthcare seeking assets. Clinical and public health practice can benefit from understanding that CRC symptoms may present similarly but assets that facilitate seeking healthcare appraisal differ based upon age. Expanding knowledge of CRC risk factors and symptoms across healthcare professionals and the general public could promote earlier appraisal regardless of age and improve outcomes for younger survivors.
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Affiliation(s)
- Jackie Knight Wilt
- Department of Health Behavior and Policy, School of Population Health, Virginia Commonwealth University, Richmond, VA, USA
| | - Laura A Siminoff
- Department of Social and Behavioral Sciences, Temple University, Philadelphia, PA, USA
| | - Maria D Thomson
- Department of Health Behavior and Policy, School of Population Health, Virginia Commonwealth University, Richmond, VA, USA.
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Kang L, Li C, Du H. Predictors of Medical Care Delay or Avoidance Among Chinese Adults During the COVID-19 Pandemic. Patient Prefer Adherence 2023; 17:3067-3080. [PMID: 38027085 PMCID: PMC10680038 DOI: 10.2147/ppa.s436794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/02/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Medical care delay or avoidance increases morbidity and mortality risk and is costly for the national healthcare system. The objective of this study was to identify factors associated with medical care delay or avoidance among Chinese adults during the COVID-19 pandemic. Materials and Methods A cross-sectional analysis was conducted using data from the 2020 China Family Panel Study (CFPS). The CFPS was conducted from July to December 2020 during the COVID-19 pandemic. The final sample included 4369 adults. A logistic regression model was employed to identify the factors associated with medical care delay or avoidance. Results The empirical results indicate that regardless of rural-urban residence, older adults and adults with chronic conditions were less likely to delay or avoid medical care during the pandemic. However, individuals who had completed more than three years of college showed a higher likelihood of delaying or avoiding medical care. In urban areas, larger family sizes, greater general trust in physicians, and higher provider structural quality were associated with a decreased probability of delaying or avoiding medical care during the pandemic. In contrast, employed adults were more likely to delay or avoid medical care. In rural areas, current smokers were more likely to delay or avoid medical care during the pandemic. Conclusion This study has identified several factors affecting medical care delay or avoidance, some of which are amenable to policy changes. Policymakers can help improve the utilization of health facilities and patient health outcomes by implementing a series of reforms.
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Affiliation(s)
- Lili Kang
- School of Health Management, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Changle Li
- School of Health Management, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Huifeng Du
- School of Health Management, Inner Mongolia Medical University, Hohhot, People’s Republic of China
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Le DD, Tran TB, Nguyen GT, Nguyen TM, Tran TXM, Nguyen LHT, Dang NTT, Van TV, Sarakarn P. Is Social Support Associated with Colorectal Cancer Care Utilization? A Multilevel Mixed-Effects Model of a Cross-Sectional Cohort Study in Vietnam. Asian Pac J Cancer Prev 2023; 24:3979-3984. [PMID: 38019258 PMCID: PMC10772773 DOI: 10.31557/apjcp.2023.24.11.3979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/17/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE To investigate the relationship between the social support (SS) and colorectal cancer (CRC) care utilization of patients in the central region of Vietnam. METHODS This was a cross-sectional cohort study in which the cohort was defined as all residential patients diagnosed with CRC in a tertiary hospital, Hue Central Hospital (HCH), in central Vietnam from 2013 to 2019. Social support was considered the main independent variable and was evaluated using the Medical Outcomes Study Social Support Survey (MOS-SSS), a self-administered 19-item SS survey. MOS-SSS is a widely used scale for assessing social support in CRC patients because it is brief, easy to use, reliable, and valid. In this study, we considered a data framework with a multilevel structure that included the patient level and duration of diagnosis as the second level. We estimated the magnitude of SS and CRC-specific treatment modalities using multilevel mixed-effects (MM) models under a hierarchical approach. RESULTS The findings indicated that CRC care utilization rates were 89.9%, 48.5%, and 30.6% for surgical resection, chemotherapy, and radiation therapy, respectively. The overall trend of SS decreased significantly and affected the CRC care utilization. We found a positive effects of overall SS, as well as emotional and tangible support, on the number of hospitalization admissions and chemotherapy utilization. CONCLUSION This study suggests that the use of the MOS-SSS should be continued in the long term for CRC patients to enhance medical accessibility and care utilization.
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Affiliation(s)
- Duong Dinh Le
- Faculty of Public Health, University of Medicine and Pharmacy, Hue University, Hue City, Thua Thien Hue Province, Vietnam.
| | - Thang Binh Tran
- Faculty of Public Health, University of Medicine and Pharmacy, Hue University, Hue City, Thua Thien Hue Province, Vietnam.
| | - Gia Thanh Nguyen
- Faculty of Public Health, University of Medicine and Pharmacy, Hue University, Hue City, Thua Thien Hue Province, Vietnam.
| | - Tu Minh Nguyen
- Office for Undergraduate Training, University of Medicine and Pharmacy, Hue University, Hue city, Thua Thien Hue Province, Vietnam.
| | - Tri Xuan Minh Tran
- Faculty of Public Health, University of Medicine and Pharmacy, Hue University, Hue City, Thua Thien Hue Province, Vietnam.
| | - Linh Hoang Thuy Nguyen
- Faculty of Public Health, University of Medicine and Pharmacy, Hue University, Hue City, Thua Thien Hue Province, Vietnam.
| | - Nha Thi Thanh Dang
- Faculty of Public Health, University of Medicine and Pharmacy, Hue University, Hue City, Thua Thien Hue Province, Vietnam.
| | - Thang Vo Van
- Faculty of Public Health, University of Medicine and Pharmacy, Hue University, Hue City, Thua Thien Hue Province, Vietnam.
| | - Pongdech Sarakarn
- Epidemiology and Biostatistics Department, Faculty of Public Health, Khon Kaen University, Thailand.
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Negash M, Temesgen B, Kassaw C, Abebe L, Moges S, Sime Y, Yimer S. Delayed treatment seeking and its associated factors among people with schizophrenia spectrum disorders who are on follow-up at Dilla University Referral Hospital in the southern region of Ethiopia, 2022: a cross-sectional study. Front Psychiatry 2023; 14:1230448. [PMID: 37799399 PMCID: PMC10549924 DOI: 10.3389/fpsyt.2023.1230448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 08/18/2023] [Indexed: 10/07/2023] Open
Abstract
Background Delay in psychiatric treatment leads to increased morbidity and mortality, as well as the emergence of several psychiatric and physical comorbidities and the use of life-threatening and life-altering self-treatments (such as licit and illicit substance misuse). Delaying detection and taking preventive measures against its modifiable factors are crucial for a better prognosis. Objective To assess delayed treatment seeking and its associated factors among people with schizophrenia spectrum disorders who are on follow-up at Dilla University Referral Hospital in the southern region of Ethiopia. Method An institution-based cross-sectional study was conducted between 8 June and 11 September at Dilla University Referral Hospital in the southern region of Ethiopia in 2022. Epicollect was used to collect data from 414 randomly selected participants using an interviewer-administered questionnaire. Delayed treatment seeking was determined using participants' medical records and a semi-structured questionnaire. The data were analyzed using Statistical Package for Social Sciences (SPSS) version 26. A logistic regression analysis was conducted to identify the explanatory variables for delayed treatment. Results The magnitude of delayed treatment seeking was 49.8% (95%CI = 44.9, 54.3). Study participants with disengaged family cohesion [AOR = 3.97, 95%CI = (2.999, 7.193)], inflexible family adaptability [AOR = 2.00, 95%CI = (1.686, 4.044)], who lack awareness about the availability of psychiatric treatment [AOR = 1.63, 95%CI = (1.362, 2.626)], high internalized stigma [AOR = 3.24, 95%CI = (2.770, 5.514)], and those with a negative attitude toward psychiatric treatment [AOR = 2.88, 95%CI = (2.034, 4.469)] had delayed seeking treatment. However, the participants whose educational status was higher than diploma [AOR = 0.040, 95%CI = (0.026, 0.077)] and high school [AOR = 0.09, 95%CI = (0.071, 0.204)] were less likely to have delayed seeking treatment. Conclusions There is a significant delay in seeking modern psychiatric treatment. Stigma, a lack of awareness of where treatment is available, disengaged family cohesion, inflexible family adaptability, distance to a health facility >5 km, and a negative attitude toward psychiatric treatment were barriers to seeking appropriate care.
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Affiliation(s)
- Misrak Negash
- Department of Psychiatry, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Bethel Temesgen
- Department of Psychiatry, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Chalachew Kassaw
- Department of Psychiatry, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Lulu Abebe
- Department of Psychiatry, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Solomon Moges
- Department of Psychiatry, College of Medicine and Health Science, Woldia University, Woldia, Ethiopia
| | - Yohanes Sime
- Department of Psychiatry, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Solomon Yimer
- Department of Psychiatry, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
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Jin J, Yang H, Guo Z, L V X, Jiang X, Ding C. Relationships of illness perception, symptoms response and social support with acute myocardial infarction patients' prehospital delay in rural China: protocol for a cross-sectional study. BMJ Open 2023; 13:e073010. [PMID: 37438062 DOI: 10.1136/bmjopen-2023-073010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Abstract
INTRODUCTION The timely treatment of acute myocardial infarction (AMI) patients is of utmost importance, and yet, there remains a significant disparity between urban and rural areas in China due to the unequal distribution of medical resources. The manifestation of symptoms and psychosocial factors play a crucial role in shaping medical decisions for AMI patients. It is well established that minimising prehospital delay (PHD) is crucial for the successful implementation of recanalisation therapy and reducing mortality in out-of-hospital settings. However, there remains a paucity of studies investigating the correlation between illness perception, symptom response, social support, and PHD in AMI patients. AIM The aim of this study was to analyse the relationship pathways between symptom response, illness perception, social support and PHD time in patients with AMI in rural areas of China. METHODS A primary care-based cross-sectional study was designed to investigate the inpatients initially diagnosed with AMI in the emergency department of three tertiary care hospitals in three counties in northern Zhejiang Province by convenience sampling method from January 2023 to December 2023. A minimum of 286 patients will be enrolled (voluntary response sample). Each participant will complete a paper-based questionnaire to gather research outcomes. Statistical analyses will be performed using logistic regression and structural equation model with PHD as main outcome parameter. DISCUSSION This is the first study of the factors influencing PHD in AMI in rural China using structural equation model. Our study will address this gap in the available research. The implementation and findings of this study may provide a reliable basis for reducing PHD in AMI patients in rural areas and establish a relevant theoretical foundation for the implementation of targeted interventions and risk prevention measures in primary care hospitals.
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Affiliation(s)
- Jingfen Jin
- Department of Nursing, Changxing County People's Hospital, Huzhou, China
- Department of Nursing, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, China
- Key Laboratory of the Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China
| | - Haifeng Yang
- Department of Nursing, Changxing County People's Hospital, Huzhou, China
| | - Zhiting Guo
- Department of Nursing, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, China
| | - Xuebing L V
- Department of Emergency, Changxing County People's Hospital, Changxing, China
| | - Xiuju Jiang
- Department of Nursing, Changxing County People's Hospital, Huzhou, China
| | - Chuanqi Ding
- Department of Nursing, Changxing County People's Hospital, Huzhou, China
- Department of Nursing, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, China
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O'Banion LA, Ozsvath K, Cutler B, Kiguchi M. A review of the current literature of ethnic, gender, and socioeconomic disparities in venous disease. J Vasc Surg Venous Lymphat Disord 2023; 11:682-687. [PMID: 37086915 DOI: 10.1016/j.jvsv.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/15/2023] [Accepted: 03/11/2023] [Indexed: 04/24/2023]
Abstract
Venous disease is prevalent, undertreated, and frequently unrecognized. During the past two decades, new treatment modalities have changed how venous disease is approached. Some of these treatment modalities are only available in certain centers or locations and access to care could be inequitable. Although venous disease affects millions in the United States, we have little understanding of the gender, socioeconomic, and ethnic disparities in both superficial and deep venous disease presentation. In an effort to better understand the treatment of male and female patients from different gender, ethnic, and socioeconomic backgrounds, literature searches were conducted to investigate how these patients were evaluated and treated. PubMed was used to search literature using the terms "venous insufficiency," "superficial venous disease," "venous thromboembolism," "deep vein thrombosis," "DVT," "May-Thurner," and "pulmonary embolism," with gender, sex, racial, and socioeconomic disparities and differences within the keywords. In addition, once articles were discovered, the "similar articles" function was used to expand the search. The included studies were restricted to those reported from 1995 to the present. Given the paucity of data, no study was excluded. It is readily apparent that there is not enough data to make decisions that would modify treatment to affect the outcomes of patients with differing backgrounds and gender. Studies currently are limited to evaluating patients by sex assigned at birth without interrogation of their identified gender. It is imperative that consideration is given to evaluating gender and ethnic differences, because treatment options might need to be tailored accordingly. Outreach and education for underserved patient populations with improvement in access to care must also be incorporated into the healthcare system. Additional work in this area is required. Further data collection and research related to demographic disparities among patients with venous disease is necessary to better understand the differences that could change treatment algorithms tailored to specific groups.
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Affiliation(s)
- Leigh Ann O'Banion
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Francisco-Fresno, Fresno, CA
| | - Kathleen Ozsvath
- Division of Vascular Surgery, Department of Surgery, St Peters Health Partners, Albany, NY
| | - Bianca Cutler
- Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Misaki Kiguchi
- Department of Vascular Surgery, MedStar Washington Hospital Center, Washington, DC.
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Psychological distress, social support, and use of outpatient care among adult men and women with coronary artery disease or other non-cardiovascular chronic disease. J Psychosom Res 2023; 165:111131. [PMID: 36610332 DOI: 10.1016/j.jpsychores.2022.111131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Psychological distress, as defined by elevations in symptoms of depression, anxiety, and/or perceived stress, is frequent in patients with chronic diseases, such as coronary artery disease (CAD). While psychological distress is known to impact disease outcomes, less is known about its influence on health care utilization, or on the factors that may modify these relationships. This prospective study examined whether 1) psychological distress predicts greater use of outpatient care services over a period of up to eight years in middle-aged to older individuals with CAD or other non-cardiovascular chronic diseases; 2) this relationship differs according to sex, presence of CAD, and/or social support. METHODS Men and women (N = 1236; aged 60.85 ± 6.95 years) with and without CAD completed validated questionnaires on symptoms of depression, anxiety, perceived stress, and social support. Number of medical outpatient visits was obtained from the Régie de l'assurance maladie du Québec. Analyses included bivariate correlations, hierarchical regressions, and moderation analyses, controlling for sociodemographic and lifestyle variables. RESULTS Psychological distress, social support, and yearly outpatient visits were significantly correlated (ps < 0.05). In regression analyses, only depressive symptoms were associated with significantly greater use of outpatient care (b = 0.048, p = .004), particularly among CAD patients (b = 0.085, p < .001). Neither sex nor social support moderated this relation. CONCLUSION Depression predicted greater outpatient visits in patients with chronic disease, especially CAD patients. More research is needed to determine whether psychosocial interventions may have an impact on health care utilization.
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Hapuarachchi T, Fernando G, Weerasingha S, Ozdemir S, Teo I, Vishwanath P, Priyanthi A, Finkelstein E, Malhotra C. Disparities in end-of-life outcomes among advanced cancer patients in Sri Lanka: Results from the APPROACH study. Palliat Support Care 2022; 20:832-838. [PMID: 36942586 DOI: 10.1017/s147895152100167x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE A Universal Health Coverage goal is to provide access to affordable palliative care to reduce disparities in end-of-life (EOL) outcomes. To assess progress toward this goal in Sri Lanka, our primary aim was to systematically assess differences in patients' physical, psychological, social and spiritual outcomes, and their perceived quality of care by their socioeconomic status (SES). METHODS As part of the multi-country APPROACH (Asian Patient Perspectives Regarding Oncology Awareness, Care and Health) study, we surveyed 199 patients with a stage IV solid malignant tumor and aged >21 years from the largest government cancer hospital in Sri Lanka. We assessed their physical (physical and functional well-being, symptom burden), psychological (anxiety, depression, emotional well-being), social (social well-being), and spiritual outcomes and perceived quality of care (physician communication, nursing care, and coordination/responsiveness). RESULTS Low SES patients reported significantly lower physical and functional well-being, emotional well-being, spiritual well-being including meaning/peace and faith; and significantly higher symptom burden, anxiety and depressive symptoms compared with patients from high SES (p < 0.05 for all outcomes). SIGNIFICANCE OF RESULTS Results have implications regarding reducing barriers in access to appropriate palliative care and EOL care services to stage IV cancer patients from low SES in Sri Lanka.
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Affiliation(s)
| | - Gvmc Fernando
- National Centre for Primary Care and Allergy Research, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | | | - Semra Ozdemir
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
| | - Irene Teo
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
| | | | | | - Eric Finkelstein
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
| | - Chetna Malhotra
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
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Bhatt S, Johnson PC, Markovitz NH, Gray T, Nipp RD, Ufere N, Rice J, Reynolds MJ, Lavoie MW, Clay MA, Lindvall C, El-Jawahri A. The Use of Natural Language Processing to Assess Social Support in Patients With Advanced Cancer. Oncologist 2022; 28:165-171. [PMID: 36427022 PMCID: PMC9907037 DOI: 10.1093/oncolo/oyac238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 10/12/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Data examining associations among social support, survival, and healthcare utilization are lacking in patients with advanced cancer. METHODS We conducted a cross-sectional secondary analysis using data from a prospective longitudinal cohort study of 966 hospitalized patients with advanced cancer at Massachusetts General Hospital from 2014 through 2017. We used NLP to identify extent of patients' social support (limited versus adequate as defined by NLP-aided review of the Electronic Health Record (EHR)). Two independent coders achieved a Kappa of 0.90 (95% CI: 0.84-1.00) using NLP. Using multivariable regression models, we examined associations of social support with: 1) OS; 2) death or readmission within 90 days of hospital discharge; 3) time to readmission within 90 days; and 4) hospital length of stay (LOS). RESULTS Patients' median age was 65 (range: 21-92) years, and a plurality had gastrointestinal (GI) cancer (34.3%) followed by lung cancer (19.5%). 6.2% (60/966) of patients had limited social support. In multivariable analyses, limited social support was not significantly associated with OS (HR = 1.13, P = 0.390), death or readmission (OR = 1.18, P = 0.578), time to readmission (HR = 0.92, P = 0.698), or LOS (β = -0.22, P = 0.726). We identified a potential interaction suggesting cancer type (GI cancer versus other) may be an effect modifier of the relationship between social support and OS (interaction term P = 0.053). In separate unadjusted analyses, limited social support was associated with lower OS (HR = 2.10, P = 0.008) in patients with GI cancer but not other cancer types (HR = 1.00, P = 0.991). CONCLUSION We used NLP to assess the extent of social support in patients with advanced cancer. We did not identify significant associations of social support with OS or healthcare utilization but found cancer type may be an effect modifier of the relationship between social support and OS. These findings underscore the potential utility of NLP for evaluating social support in patients with advanced cancer.
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Affiliation(s)
| | - P Connor Johnson
- Corresponding author: P. Connor Johnson, MD, Massachusetts General Hospital Cancer Center, 55 Fruit St., Yawkey 9A, Boston, MA 02114, USA. Tel: +1 617 724 4000; Fax: +1 617 724 1135; E-mail:
| | - Netana H Markovitz
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Tamryn Gray
- Harvard Medical School, Boston, MA, USA,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ryan D Nipp
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Nneka Ufere
- Harvard Medical School, Boston, MA, USA,Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Brigham and Women’s Hospital, Boston, MA, USA
| | - Julia Rice
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Matthew J Reynolds
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Mitchell W Lavoie
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Madison A Clay
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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11
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Pang A, Jiali L, Ng A, Cheng J, Wang M, Ng YS, Yao Y, Chun M, Ho F, Tey J. Use of the Cancer and Aging Research Group Predictive Model for Chemotherapy-Related Toxic Effects in a Multiethnic, Older Adult Asian Population. JAMA Netw Open 2022; 5:e2237196. [PMID: 36255721 PMCID: PMC9579905 DOI: 10.1001/jamanetworkopen.2022.37196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The Cancer and Aging Research Group (CARG) prediction model for chemotherapy-related toxic effects has been developed but not yet validated in older Asian adults. In view of differences in drug metabolism and toxic effect reporting in the Asian population, the ability of this tool to guide the cancer treatment decision-making process in older Asian adults needs to be assessed. OBJECTIVE To examine the validity of the CARG predictive model in a multiethnic Asian cohort of older adults. DESIGN, SETTING, AND PARTICIPANTS In this prognostic study, patients of various Asian ethnicities 70 years or older with a solid tumor diagnosis receiving chemotherapy at the National University Cancer Institute, Singapore, were accrued from June 1, 2017, to January 1, 2019. Their risks of chemotherapy-related toxic effects were calculated using the CARG tool. A geriatric assessment was performed, and the treating oncologist (blinded to the CARG scores) was asked to give an estimated likelihood of toxic effects (low, medium, or high). Chemotherapy-related toxic effects were recorded during each clinic visit. Validation of the prediction model was performed by calculating the area under the receiver operating characteristic curve. Multivariate analyses were performed to identify variables in other domains in the geriatric assessment predicting for severe toxic effects. MAIN OUTCOMES AND MEASURES Grade 3 to 5 toxic effects and hospitalization. RESULTS The study included 200 patients (median age, 74 years [range, 70-89 years]; 110 [55.0%] male; 177 [88.5%] Chinese, 17 [8.5%] Malay, 4 [2.0%] Indian, and 2 [1.0%] other ethnicities [according to Singapore's national system of race classification]). A total of 137 patients (68.5%) experienced grade 3 to 5 toxic effects, and 131 (65.5%) required hospitalization. The area under the receiver operating characteristic curve for the CARG chemotoxicity prediction model was 0.74 (95% CI, 0.67-0.82), retaining good discrimination in the study population. CONCLUSIONS AND RELEVANCE This prognostic study conducted in a multiethnic Asian cohort of older adults supports the validity of the CARG predictive model in this population, predicting which older adults are at risk of chemotherapy-related toxic effects.
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Affiliation(s)
- Angela Pang
- Department of Haematology Oncology, National University Cancer Institute, Singapore
| | - Low Jiali
- Department of Haematology Oncology, National University Cancer Institute, Singapore
| | - Alex Ng
- Yong Loo Lin School of Medicine, National University of Singapore
| | - Joseph Cheng
- Yong Loo Lin School of Medicine, National University of Singapore
| | - Meng Wang
- Department of Medicine, National University Hospital, Singapore
| | - Yean Shin Ng
- Department of Haematology Oncology, National University Cancer Institute, Singapore
| | - Yao Yao
- Department of Pharmacy, National University Hospital, Singapore
| | - Meiling Chun
- Department of Surgery, Ng Teng Fong General Hospital, Singapore
| | - Francis Ho
- Department of Radiation Oncology, National University Cancer Institute, Singapore
| | - Jeremy Tey
- Department of Radiation Oncology, National University Cancer Institute, Singapore
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12
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Diefenhardt M, Martin D, Ludmir EB, Fleischmann M, Hofheinz RD, Ghadimi M, Kosmala R, Polat B, Friede T, Minsky BD, Rödel C, Fokas E. Development and Validation of a Predictive Model for Toxicity of Neoadjuvant Chemoradiotherapy in Rectal Cancer in the CAO/ARO/AIO-04 Phase III Trial. Cancers (Basel) 2022; 14:cancers14184425. [PMID: 36139585 PMCID: PMC9497244 DOI: 10.3390/cancers14184425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/30/2022] [Accepted: 09/06/2022] [Indexed: 11/16/2022] Open
Abstract
Background: There is a lack of predictive models to identify patients at risk of high neoadjuvant chemoradiotherapy (CRT)-related acute toxicity in rectal cancer. Patient and Methods: The CAO/ARO/AIO-04 trial was divided into a development (n = 831) and a validation (n = 405) cohort. Using a best subset selection approach, predictive models for grade 3−4 acute toxicity were calculated including clinicopathologic characteristics, pretreatment blood parameters, and baseline results of quality-of-life questionnaires and evaluated using the area under the ROC curve. The final model was internally and externally validated. Results: In the development cohort, 155 patients developed grade 3−4 toxicities due to CRT. In the final evaluation, 15 parameters were included in the logistic regression models using best-subset selection. BMI, gender, and emotional functioning remained significant for predicting toxicity, with a discrimination ability adjusted for overfitting of AUC 0.687. The odds of experiencing high-grade toxicity were 3.8 times higher in the intermediate and 6.4 times higher in the high-risk group (p < 0.001). Rates of toxicity (p = 0.001) and low treatment adherence (p = 0.007) remained significantly different in the validation cohort, whereas discrimination ability was not significantly worse (DeLong test 0.09). Conclusion: We developed and validated a predictive model for toxicity using gender, BMI, and emotional functioning. Such a model could help identify patients at risk for treatment-related high-grade toxicity to assist in treatment guidance and patient participation in shared decision making.
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Affiliation(s)
- Markus Diefenhardt
- Department of Radiotherapy and Oncology, University of Frankfurt, 60596 Frankfurt, Germany
- Frankfurt Cancer Institute, 60596 Frankfurt, Germany
- Correspondence: ; Tel.: +49-(0)69-63015130; Fax: +49-(0)69-63015091
| | - Daniel Martin
- Department of Radiotherapy and Oncology, University of Frankfurt, 60596 Frankfurt, Germany
- German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Partner Site, Frankfurt, 69120 Heidelberg, Germany
| | - Ethan B. Ludmir
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA
| | - Maximilian Fleischmann
- Department of Radiotherapy and Oncology, University of Frankfurt, 60596 Frankfurt, Germany
| | - Ralf-Dieter Hofheinz
- Department of Medical Oncology, University Hospital Mannheim, 68167 Mannheim, Germany
| | - Michael Ghadimi
- Department of General and Visceral Surgery, University Medical Center Göttingen, 37075 Göttingen, Germany
| | - Rebekka Kosmala
- Department of Radiation Oncology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Bülent Polat
- Department of Radiation Oncology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, 37075 Göttingen, Germany
| | - Bruce D. Minsky
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA
| | - Claus Rödel
- Department of Radiotherapy and Oncology, University of Frankfurt, 60596 Frankfurt, Germany
- Frankfurt Cancer Institute, 60596 Frankfurt, Germany
- German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Partner Site, Frankfurt, 69120 Heidelberg, Germany
| | - Emmanouil Fokas
- Department of Radiotherapy and Oncology, University of Frankfurt, 60596 Frankfurt, Germany
- Frankfurt Cancer Institute, 60596 Frankfurt, Germany
- German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Partner Site, Frankfurt, 69120 Heidelberg, Germany
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13
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Shukla P, Lee M, Whitman S, Pine K. Delay of routine health care during the COVID-19 pandemic: A qualitative study of individuals’ risk assessment and decision making. Soc Sci Med 2022; 307:115164. [PMID: 35816834 PMCID: PMC9217083 DOI: 10.1016/j.socscimed.2022.115164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/18/2022] [Accepted: 06/19/2022] [Indexed: 11/26/2022]
Abstract
Delaying routine health care has been prevalent during the COIVD-19 pandemic. Macro-level data from this period reveals that U.S. patients under-utilized routine health care services such as primary care visits, preventative tests, screenings, routine optometry care, dental appointments, and visits for chronic disease management. Yet, there is a gap in research on how and why patients understand risks associated with seeking or delaying routing health care during an infectious disease pandemic. Our research addresses this gap based on semi-structured interviews with 40 participants living in regions across the United States. By building upon Unger-Saldaña and Infante-Castañeda's model of delayed health care, we extend this model by articulating how health care delays happen during an infectious disease pandemic. Specifically, we show how perceptions of uncertainty and subjective risk assessments shape people's decisions to delay routine health care while they operate at two levels, internal and external to one's social bubble, interacting with each other.
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14
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Yin H, Jiang C, Shi X, Chen Y, Yu X, Wang Y, Li W, Ma H, Geng Q. Job Burnout Is Associated With Prehospital Decision Delay: An Internet-Based Survey in China. Front Psychol 2022; 13:762406. [PMID: 35496161 PMCID: PMC9045849 DOI: 10.3389/fpsyg.2022.762406] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 03/10/2022] [Indexed: 12/05/2022] Open
Abstract
Background Prehospital delay is associated with non-modifiable factors such as age, residential region, and disease severity. However, the impact of psychosocial factors especially for job burnout on prehospital decision delay is still little understood. Method This internet-based survey was conducted between 14 February 2021 and 5 March 2021 in China through the Wechat platform and web page. Self-designed questionnaires about the expected and actual length of prehospital decision time and the Chinese version of Maslach Burnout Inventory-General Survey, Type D Personality Scale-14, and Social Support Rating Scale were applied. A total of 1,039 general participants with a history of perceptible but tolerable body discomfort were included. Results The top six reasons for prehospital decision delay were: (1) endure until self-healing (50.7%), (2) too busy to ask for leave (40.3%), (3) process for seeing a doctor too complicated (35.8%), (4) too tired after work (26.2%), (5) worry about the expenditure (16.6%), and (6) fear of being identified as with serious problem (14.5%). The univariate analyses revealed that older age (p = 0.001), type D personality (p = 0.025), job burnout (p = 0.055), and worrying about expenditure (p = 0.004) were associated with prolonged prehospital decision time, while engaged in medical-related job (p = 0.028) and with more social support (p = 0.066) would shorten the delay. The multivariate analysis using logistic regression model with forward selecting method showed that age [per 10 years, odds ratio (OR) 1.19 (1.09–1.31), p < 0.001], job burnout [per 10 points in Maslach Burnout Inventory-General Survey (MBI-GS), OR 1.17 (1.04–1.31), p = 0.007], and worrying about expenditure [OR 1.75 (1.25–2.47), p = 0.001] were the three determinants for prehospital decision delay (>7 days). Mediating effects were analyzed by using bias-corrected percentile bootstrap methods (N = 10,000). Social support was found partially mediated the relationship between the determinants and prehospital decision time. The partial mediating effect of social support accounted for 24.0% of the total effect for job burnout and 11.6% for worrying about expenditure. Conclusion Psychosocial factors have a non-negligible impact on prehospital decision delay. The crucial part of prehospital decision delay may be the lack of motivation inside. Job burnout and lack of social support, as two commonly seen features in the modern world, should be given enough consideration in disease prevention and treatment.
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Affiliation(s)
- Han Yin
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Cheng Jiang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaohe Shi
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yilin Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,School of Medicine, South China University of Technology, Guangzhou, China
| | - Xueju Yu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yu Wang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Weiya Li
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Huan Ma
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Department of Cardiac Rehabilitation, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qingshan Geng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,School of Medicine, South China University of Technology, Guangzhou, China
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15
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Sabeti S, Ochtli CR, Tay-Lasso E, Whelton M, Burton K, Bernal NO, Joe VC, Chin TL. The Effects of the COVID-19 Pandemic on Burn Clinic. J Burn Care Res 2022; 43:766-771. [PMID: 35488371 PMCID: PMC9047216 DOI: 10.1093/jbcr/irac041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The COVID-19 pandemic has led to anxiety and fears for the general public. It is unclear how the behavior of people with acute burns and the services available to them has changed during the pandemic. The aim of our observational study was to evaluate our clinic’s experience with patients presenting with burns during the first ten months of the COVID-19 pandemic and determine if delays in presentation and healthcare delivery exist within our burn population. Patients referred to our clinic from March 1, 2020 to Dec 15, 2020 were reviewed for time of presentation after injury. We defined a true delay in presentation of >5 days from date of injury to date of referral for patients who were not inpatients at our facility or received initial care elsewhere prior to referral. Of the 246 patients who were referred to our clinic, during this time period, 199 patients (80.89%) attended their appointments. Our in-person clinic volume from referrals increased in July 2020 with a sharp decrease in August 2020. Our total clinic volume decreased in 2020 from 2019 by about 14%. Referrals to our clinic decreased in 2020 from 2019 by about 34%. Video telehealth visits did not account for the decrease in visits. There was low incidence of delays in presentation to our clinic during the pandemic. Additional investigation is necessary to see if the incidence of burn injury decreased. Despite the pandemic, our clinic remained ready and open to serve the burn population.
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Affiliation(s)
- Sara Sabeti
- Department of Surgery, University of California at Irvine, USA
| | - Ché R Ochtli
- Department of Surgery, University of California at Irvine, USA
| | - Erika Tay-Lasso
- Department of Surgery, University of California at Irvine, USA
| | - Melissa Whelton
- Department of Surgery, University of California at Irvine, USA
| | - Kimberly Burton
- Department of Surgery, University of California at Irvine, USA
| | - Nicole O Bernal
- Department of Surgery, University of California at Irvine, USA
| | - Victor C Joe
- Department of Surgery, University of California at Irvine, USA
| | - Theresa L Chin
- Department of Surgery, University of California at Irvine, USA
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16
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Yang G, D'Arcy C. Physical activity and social support mediate the relationship between chronic diseases and positive mental health in a national sample of community-dwelling Canadians 65+: A structural equation analysis. J Affect Disord 2022; 298:142-150. [PMID: 34728294 DOI: 10.1016/j.jad.2021.10.055] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 10/15/2021] [Accepted: 10/23/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Mental health is a critical component of healthy aging. Aging increases the likelihood of developing chronic diseases. The negative effects of chronic diseases on mental health have been extensively documented. Physical activity and social support have been reported to influence mental health positively. METHODS Data analyzed are drawn from the national Canadian Community Health Survey - Mental Health in 2012. Structural equation modeling (SEM) techniques were used to estimate and test the mediating role of physical activities and social support in the relationship between chronic disease, positive mental health, and psychological distress in a national adult population sample aged 65+. RESULTS Approximately 83% of the older adults sample reported having at least one chronic disease, and the mean score of psychological distress and positive mental health was 14.15 ± 4.73 and 55.28 ± 10.67, respectively. Initial analysis found that chronic illness was negatively related to positive mental health (β= -0.72, P < 0.001) and positively related to psychological distress (β=0.98, P < 0.001). The final structural model found that physical activity and social support partially mediated the negative consequences of chronic disease on psychological distress and strengthened seniors' positive mental health. LIMITATIONS Limiting causal attribution, potential reporting bias and limited in recognizing negative and positive social support are the major limitations. CONCLUSIONS Older adults with chronic diseases should be encouraged to increase physical activity and social support levels. The study outcomes have clinical implications for the delivery of mental health services to improve mental health and resilience to coping with stress among older adults.
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Affiliation(s)
- Guang Yang
- School of Public Health, University of Saskatchewan, 104 Clinc Place, Saskatoon, Saskatchewan, S7N 2Z4, Canada
| | - Carl D'Arcy
- School of Public Health, University of Saskatchewan, 104 Clinc Place, Saskatoon, Saskatchewan, S7N 2Z4, Canada; Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan S7N 0W8, Canada.
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17
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Kalyanaraman Marcello R, Dolle J, Tariq A, Kaur S, Wong L, Curcio J, Thachil R, Yi SS, Islam N. Disaggregating Asian Race Reveals COVID-19 Disparities Among Asian American Patients at New York City's Public Hospital System. Public Health Rep 2021; 137:317-325. [PMID: 34965776 DOI: 10.1177/00333549211061313] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Data on the health burden of COVID-19 among Asian American people of various ethnic subgroups remain limited. We examined COVID-19 outcomes of people of various Asian ethnic subgroups and other racial and ethnic groups in an urban safety net hospital system. METHODS We conducted a retrospective analysis of 85 328 adults aged ≥18 tested for COVID-19 at New York City's public hospital system from March 1 through May 31, 2020. We examined COVID-19 positivity, hospitalization, and mortality, as well as demographic characteristics and comorbidities known to worsen COVID-19 outcomes. We conducted adjusted multivariable regression analyses examining racial and ethnic disparities in mortality. RESULTS Of 9971 Asian patients (11.7% of patients overall), 48.2% were South Asian, 22.2% were Chinese, and 29.6% were in other Asian ethnic groups. South Asian patients had the highest rates of COVID-19 positivity (30.8%) and hospitalization (51.6%) among Asian patients, second overall only to Hispanic (32.1% and 45.8%, respectively) and non-Hispanic Black (27.5% and 57.5%, respectively) patients. Chinese patients had a mortality rate of 35.7%, highest of all racial and ethnic groups. After adjusting for demographic characteristics and comorbidities, only Chinese patients had significantly higher odds of mortality than non-Hispanic White patients (odds ratio = 1.44; 95% CI, 1.04-2.01). CONCLUSIONS Asian American people, particularly those of South Asian and Chinese descent, bear a substantial and disproportionate health burden of COVID-19. These findings underscore the need for improved data collection and reporting and public health efforts to mitigate disparities in COVID-19 morbidity and mortality among these groups.
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Affiliation(s)
| | - Johanna Dolle
- Office of Ambulatory Care and Population Health, New York City Health + Hospitals, New York, NY, USA
| | - Areeba Tariq
- Office of Ambulatory Care and Population Health, New York City Health + Hospitals, New York, NY, USA
| | - Sharanjit Kaur
- Office of Ambulatory Care and Population Health, New York City Health + Hospitals, New York, NY, USA
| | - Linda Wong
- New York City Health + Hospitals/Elmhurst, Queens, NY, USA
| | - Joan Curcio
- New York City Health + Hospitals/Elmhurst, Queens, NY, USA
| | - Rosy Thachil
- New York City Health + Hospitals/Jacobi, Bronx, NY, USA
| | - Stella S Yi
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Nadia Islam
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
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18
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Natour AK, Rteil A, Corcoran P, Weaver M, Ahsan S, Kabbani L. Socioeconomic status and clinical stage of patients presenting for treatment of chronic venous disease. Ann Vasc Surg 2021; 83:305-312. [PMID: 34954041 DOI: 10.1016/j.avsg.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/22/2021] [Accepted: 12/03/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The association between socioeconomic status (SES) and chronic venous insufficiency has not been rigorously studied. This study aimed to determine the influence of SES on the clinical stage of patients presenting for chronic venous disease therapy. METHODS We performed a retrospective study of a prospectively collected data from the Vascular Quality Initiative Varicose Vein Registry at our tertiary referral center. Medical records of patients who underwent therapy for chronic venous disease between January 2015 and June 2019 were queried. SES was quantified using the neighborhood deprivation index (NDI), which summarizes 8 domains of socioeconomic deprivation and is based on census tract data derived from the patients' addresses at the time of the treatment. High NDI scores correspond with lower SES. The association between SES and severity of vein disease at presentation was assessed with bivariate analysis of variance and linear regression analysis. RESULTS A total of 449 patients with complete SES and clinical-etiology-anatomy-pathophysiology (CEAP) class data were included in the study. The mean age was 58 years, 67% were female, and 60% were White. CEAP classes were distributed as follows C2, 22%; C3, 50%; C4, 15%; C5, 5%; and C6, 8%. Patients with lower SES (higher NDI score) tended to have a higher CEAP class at presentation (P < 0.05). SES was not associated with history of deep venous thrombosis, use of compression therapy, or venous clinical severity score. CONCLUSIONS At our institution, patients with more advanced venous disease tended to belong to a lower SES group. This may reflect that patients with a lower SES have a longer time to presentation due to delay in seeking medical help for venous disease.
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Affiliation(s)
| | - Ali Rteil
- Division of Vascular Surgery, Henry Ford Hospital, Detroit, MI
| | - Paul Corcoran
- Division of Vascular Surgery, Henry Ford Hospital, Detroit, MI
| | - Mitchell Weaver
- Division of Vascular Surgery, Henry Ford Hospital, Detroit, MI
| | - Syed Ahsan
- Division of Vascular Medicine, Henry Ford Hospital, Detroit, MI
| | - Loay Kabbani
- Division of Vascular Surgery, Henry Ford Hospital, Detroit, MI.
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19
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Johnson PC, Markovitz NH, Gray TF, Bhatt S, Nipp RD, Ufere N, Rice J, Reynolds MJ, Lavoie MW, Topping CEW, Clay MA, Lindvall C, El-Jawahri A. Association of Social Support With Overall Survival and Healthcare Utilization in Patients With Aggressive Hematologic Malignancies. J Natl Compr Canc Netw 2021:1-7. [PMID: 34653964 DOI: 10.6004/jnccn.2021.7033] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/02/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Social support plays a crucial role for patients with aggressive hematologic malignancies as they navigate their illness course. The aim of this study was to examine associations of social support with overall survival (OS) and healthcare utilization in this population. METHODS A cross-sectional secondary analysis was conducted using data from a prospective longitudinal cohort study of 251 hospitalized patients with aggressive hematologic malignancies at Massachusetts General Hospital from 2014 through 2017. Natural Language Processing (NLP) was used to identify the extent of patients' social support (limited vs adequate as defined by NLP-aided chart review of the electronic health record). Multivariable regression models were used to examine associations of social support with (1) OS, (2) death or readmission within 90 days of discharge from index hospitalization, (3) time to readmission within 90 days, and (4) index hospitalization length of stay. RESULTS Patients had a median age of 64 years (range, 19-93 years), and most were White (89.6%), male (68.9%), and married (65.3%). A plurality of patients had leukemia (42.2%) followed by lymphoma (37.9%) and myelodysplastic syndrome/myeloproliferative neoplasm (19.9%). Using NLP, we identified that 8.8% (n=22) of patients had limited social support. In multivariable analyses, limited social support was associated with worse OS (hazard ratio, 2.00; P=.042) and a higher likelihood of death or readmission within 90 days of discharge (odds ratio, 3.11; P=.043), but not with time to readmission within 90 days or with index hospitalization length of stay. CONCLUSIONS In this cohort of hospitalized patients with aggressive hematologic malignancies, we found associations of limited social support with lower OS and a higher likelihood of death or readmission within 90 days of hospital discharge. These findings underscore the utility of NLP for evaluating the extent of social support and the need for larger studies evaluating social support in patients with aggressive hematologic malignancies.
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Affiliation(s)
- P Connor Johnson
- 1Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital
- 2Harvard Medical School
| | - Netana H Markovitz
- 1Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital
| | - Tamryn F Gray
- 2Harvard Medical School
- 3Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute
| | - Sunil Bhatt
- 1Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital
| | - Ryan D Nipp
- 1Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital
- 2Harvard Medical School
| | - Nneka Ufere
- 2Harvard Medical School
- 4Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital; and
| | - Julia Rice
- 5Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Matthew J Reynolds
- 5Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mitchell W Lavoie
- 5Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Carlisle E W Topping
- 5Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Madison A Clay
- 5Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Charlotta Lindvall
- 2Harvard Medical School
- 3Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute
| | - Areej El-Jawahri
- 1Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital
- 2Harvard Medical School
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20
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Antonacci CL, Omari AM, Zaifman J, Baig AF, Sommi CP, Medvedev G, Savoie FH, Sethi PM, Klein GR, Koerner JD, Alberta FG. Differences in Patient and Physician Perceptions of Urgency for Musculoskeletal Conditions During the COVID-19 Pandemic. Orthopedics 2021; 44:e534-e538. [PMID: 34292807 DOI: 10.3928/01477447-20210618-13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In 2020, the coronavirus disease 2019 (COVID-19) pandemic limited musculoskeletal care to urgent or "nonelective" office visits and procedures. No guidelines exist to inform patients or physicians what meets these criteria. The purpose of this multi-institutional study was to describe the differences in perceptions of urgency for musculoskeletal complaints between patients and providers during the COVID-19 pandemic. An anonymous survey was distributed to patients who visited the authors' orthopedic clinics in January and February 2020 and practicing orthopedic surgeons. The surveys were administered in May 2020 after COVID-19 was officially labeled a pandemic and included questions regarding demographic information and perceptions of orthopedic urgency. A total of 1491 patients and 128 physicians completed the surveys. A significantly higher percentage of physicians considered the following diagnoses an appropriate indication for an urgent visit compared with patients: fracture (P<.001), acute dislocation (P<.001), infection (P<.001), neurologic compromise (P<.001), tumor (P<.001), acute tendon injury (P<.001), weakness (P<.001), inability to bear weight (P<.001), post-surgical problem (P<.001), and painful joint effusion (P<.001). There were no significant differences in the perception of urgency for the following conditions: bursitis/tendonitis (P=1.00), joint/extremity deformity without pain (P=.113), and loss of range of motion of a joint (P=.467). Younger patients and those with higher levels of education were significantly more likely to consider their conditions urgent. Patients may require additional education to prevent delay in treatment of urgent conditions-especially time-sensitive conditions such as neurologic compromise, tumors, and infections-when access to physicians is limited. [Orthopedics. 2021;44(4):e534-e538.].
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Pinto G, Greenblatt-Kimron L, Marai I, Lorber A, Lowenstein A, Cohen M. The Role of Affect as a Mediator between Coping Resources and Heart Rate Variability among Older Adults. Exp Aging Res 2021; 48:136-149. [PMID: 34133261 DOI: 10.1080/0361073x.2021.1923326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Heart rate variability (HRV) has been suggested as an indicator of capacity to adapt effectively to physiological or environmental challenges and of physical and psychological health in old age. AIMS The study assessed levels of high-frequency HRV (HF-HRV) among older adults in relation to positive and negative affect and the mediating role of positive and negative affect in the association between coping resources (perceived social support and sense of mastery) and HF-HRV. METHOD Participants were 187 men and women in three assisted-living residences who were independent in activities of daily living (93.4% participation rate). The participants completed sense of mastery, multidimensional scale of perceived social support, and positive and negative affect questionnaires. HF-HRV was derived from electrocardiography data measured by a Holter monitoring device for 15 minutes. RESULTS The empirical model showed good fit indices indicating that higher HF-HRV was associated with lower negative affect, and negative affect mediated the association between perceived social support and HF-HRV. In addition, perceived social support and sense of mastery were associated with higher positive affect and lower negative affect. CONCLUSIONS Although this was a cross-sectional study, it suggests that HF-HRV may be a link between affect and health in old age. It also suggests the importance of identification and intervention with older adults and their support systems to reduce negative affect.
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Affiliation(s)
- Galit Pinto
- Department of Gerontology, University of Haifa, Haifa,Israel.,Geriatric Hospital Rehabilitation-Bait Balev, Nesher, Israel
| | | | - Ibrahim Marai
- Cardiovascular Department, Baruch Padeh Medical Center, Poriya, Israel and the Azrieli Faculty of Medicine, Bar Ilan University, Israel
| | - Avraham Lorber
- Pediatric Cardiology Rambam Health Care Campus, Haifa, Israel
| | | | - Miri Cohen
- School of Social Work, University of Haifa, Haifa, Israel
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Ozambela M, Wang Y, Leow JJ, Silverman SG, Chung BI, Chang SL. Contemporary trends in percutaneous renal mass biopsy utilization in the United States. Urol Oncol 2020; 38:835-843. [PMID: 32912815 DOI: 10.1016/j.urolonc.2020.07.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/11/2020] [Accepted: 07/17/2020] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Patients with a renal mass traditionally proceed directly to surgery without a preoperative tissue diagnosis confirming malignancy. Many surgically treated renal masses represent benign tumors or indolent malignancies on final pathology. This has led to a growing body of literature supporting an expanded role for percutaneous renal mass biopsy (RMB). This study aims to characterize national trends in RMB utilization. METHODS Patients undergoing renal biopsy during a 12-year period (2006-2017) in the Premier Hospital Database were captured using International Classification of Diseases, Ninth Revision and Tenth Revision codes. We restricted our analysis to patients with a concurrent diagnosis of a renal mass. We determined utilization rate, subsequent interventions within 90 days of biopsy, predictors of RMB, and 30-day RMB complication rates. We applied sampling weights and adjusted for hospital clustering to achieve a nationally representative analysis. RESULTS Among 115,511 patients who met the inclusion criteria, the annual number of RMB rose from 7,196 in 2006 to 11,528 in 2017; during this period, more than 3 times as many patients proceeded directly to surgery without a prior RMB. After RMB, 85,848 (74.32%) patients were not treated within 90 days. Of those treated, thermal ablation was more common than surgery (17,269 vs. 12,394). Trend analysis showed that patients with metastatic disease represented a decreasing proportion of patients receiving RMB (27.0%-21.8%; P < 0.001). Compared to patients who proceeded directly to surgery, RMB was more commonly performed in patients in the highest age group (80 years and older, 15.9% vs. 9.2%), unmarried (50% vs. 45.9%), with more medical comorbidities (Charlson comorbidity index ≥4, 30.9% vs. 17.4%), or with metastatic disease (24.5% vs. 10.4%). Multivariable regression analysis determined the primary predictor of RMB was the presence of metastatic disease. Hematuria was the most common complication present in 5.18% of patients followed by pneumothorax in 1.75%. All other complications were rare (<0.4%). CONCLUSION Although there has been progressive adoption of RMB for the management of renal masses in the United States, utilization remains relatively limited and differentially employed across the population based on both clinical and nonclinical patient factors. More research is needed to understand which factors are considered when determining whether to utilize RMB in the evaluation of a renal mass.
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Affiliation(s)
- Manuel Ozambela
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ye Wang
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jeffrey J Leow
- Department of Urology, Tan Tock Seng Hospital, Singapore
| | - Stuart G Silverman
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Benjamin I Chung
- Department of Urology, Stanford University Medical Center, Stanford, CA
| | - Steven L Chang
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA.
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Medical Dance/Movement Therapy in the Infusion Room: A Model for Individual Sessions with Adults in Active Treatment. AMERICAN JOURNAL OF DANCE THERAPY 2020. [DOI: 10.1007/s10465-020-09323-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Morowatisharifabad MA, Rahimi T, Farajkhoda T, Zadeh HF. Understanding Interpersonal Influences on the Use of Formal Health Services among a Population of Iranian Women in Reproductive Age: A Qualitative Study. Open Access Maced J Med Sci 2019; 7:1531-1535. [PMID: 31198468 PMCID: PMC6542402 DOI: 10.3889/oamjms.2019.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/15/2019] [Accepted: 04/16/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND One of the most important factors contributing to using formal health care services by women is people who are involved in the social network around them. AIM This study aimed to understand the interpersonal influences on the use of formal health services among Iranian women of reproductive age. METHODS This study is a deductive content analysis approach based on the Health Promotion Model. Twenty-two semi-structured interviews were done with women of reproductive age and health care staffs in Qom, Iran. Transcripts were analysed by a deductive content analysis approach based on the Health Promotion Model (HPM). RESULTS Three main categories and eight subcategories were drawn consisting of (1) social support with 4 subcategories including "Family support and influence", "support of religious people", "support of health care providers" and "negative social support"; (2) social pressure and expectations with 2 subcategories including "feeling pressure due to role-playing" and "society's expectations regarding women's health", and (3) healthy role models with 2 subcategories including "family role models" and "modeling friends and peers in taking action for treatment". CONCLUSION A positive interpersonal influence in women acts as a strong incentive to seek health care when they are suffering from a disease, and prevents the chronicity of the disease by timely treatment.
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Affiliation(s)
| | - Tahereh Rahimi
- Department of Health Education and Promotion, School of Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Tahmineh Farajkhoda
- Research Center for Nursing and Midwifery Care, School of Nursing and Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossein Fallah Zadeh
- Department of Biostatistics and Epidemiology, Research Center of Prevention and Epidemiology of Non-Communicable Disease, School of Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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